Tuesday, March 24, 2015

WORLD TB DAY : 24th MARCH 2015

Today, 24th March 2015,is being observed as 'World TB Day" .
Itcommemorates the day in 1882 when Dr
Robert Koch astounded the scientific communityat the University of
Berlin's Institute of Hygiene by announcing that he had discovered the
cause of tuberculosis, the TB bacillus. At the
time of Koch's announcement in Berlin, TB was raging through Europe and the
Americas, causing the death of one out of every seven people. Koch's discovery
opened the way toward diagnosing and curing tuberculosis.

What happened on 24th
March 1882 :

On the evening of 24 March 1882,
Robert Koch announced to the Berlin
Physiological Society that he had discovered the cause of tuberculosis. He had
conclusively stained bacilli in lung tubercles from animals infected with
tuberculosis, a discovery that proved to be a turning point for the scientific
world in understanding the deadly disease that had plagued humankind for
millennia. Robert Koch began by reminding the audience of terrifying
statistics: "If the importance of a disease for mankind is measured by the
number of fatalities it causes, then tuberculosis must be considered much more
important than those most feared infectious diseases, plague, cholera and the
like. One in seven of all human beings dies from tuberculosis. If one only
considers the productive middle-age groups, tuberculosis carries away
one-third, and often more."

Koch's lecture, considered by many to be the
most important in medical history, was so innovative, inspirational and
thorough that it set the stage for the scientific procedures of the twentieth
century. He described how he had invented a new staining method and
demonstrated it for the audience. Koch brought his entire laboratory to the
lecture room: microscopes, test tubes with cultures, glass slides with stained
bacteria, dyes, reagents, glass jars with tissue samples, etc.He wanted the audience to check his findings
for themselves. Koch showed tissue dissections from guinea pigs which were
infected with tuberculous material from
the lungs of infected apes, from the brains and lungs of humans who had died
from blood-borne tuberculosis, from the cheesy masses in lungs of chronically
infected patients and from the abdominal cavities of cattle infected with TB.
In all cases, the disease which had developed in the experimentally infected
guinea pigs was the same, and the cultures of bacteria taken from the infected
guinea pigs were identical.

One important scientist in the audience was Paul
Ehrlich (Nobel Laureate in Physiology or Medicine in 1908) who later confessed,
"I hold that evening to be the most important experience of my scientific
life." According to Paul Ehrlich, “At this memorable session, Koch appeared
before the public with an announcement which marked a turning-point in the
story of a virulent human infectious disease. In clear, simple words Koch
explained the aetiology of tuberculosis with convincing force, presenting many
of his microscope slides and other pieces of evidence.”

When Koch ended his lecture there was complete silence. No questions,
no congratulations, no applause. The audience was stunned. Slowly people got up
and started looking into the microscopes to see the TB bacteria with their own
eyes.

The Origin and Purpose of the World TB Day :

In 1982, on the one-hundredth
anniversary of Robert Koch's presentation, the International Union Against
Tuberculosis and Lung Disease (IUATLD) proposed that March 24 be proclaimed an
official World TB Day. This was part of a year-long centennial effort by the
IUATLD and the World Health Organization under the theme “Defeat TB: Now and Forever.”
World TB Day was not officially recognized as an annual occurrence by WHO's
World Health Assembly and the United Nations until over a decade later. In
1996, WHO, KNCV, the IUATLD and other concerned organizations joined to conduct
a wide range of World TB Day activities.

The world TB day aims to spread the public awarenessof tuberculosis and the initiatives to
control it and cure it. To do so,a
theme is identified every year .

Following
discussions and consultation with partners, the Stop TB Partnership has
announced the theme for World TB Day 2015. The overall theme will continue on
from 2014 -- Reach
the 3 Million. The main
sub-theme and message for this year will be "Reach, Treat, Cure Everyone".

World TB Day 2015, emphasizes on all partners to for a global effort to
continue their commitment to find, treat and cure all people with TB and
accelerate progress towards the bold goal of ending TB by 2035.This World TB Day 2015 will signal a renewed
effort to alert health authorities to
the global, regional and national TB emergency, emphasizing the unacceptable
situation that many cases of TB go undiagnosed, untreated or are not cured. It
is a chance to engage with National TB Programme Managers and other
stakeholders to improve the quality of existing programmes and the access to
care and services.

On March 24,
1882, Robert Koch announced to the Berlin Physiological Society that he had
discovered the cause of tuberculosis. Three weeks later, on April 10, he
published an article entitled "The Etiology of Tuberculosis" (1). In
1884, in a second paper with the same title, he first expounded "Koch's
postulates," which have since become basic to studies of all infectious
diseases. He had observed the bacillus in association with all cases of the
disease, had grown the organism outside the body of the host, and had
reproduced the disease in a susceptible host inoculated with a pure culture of
the isolated organism.

Koch
continued his studies on tuberculosis, hoping to find a cure. In 1890, he
announced the discovery of tuberculin, a substance derived from tubercle
bacilli, which he thought was capable of arresting bacterial development
in_vitro and in animals. This news gave rise to tremendous hope throughout the
world, which was soon replaced by disillusionment when the product turned out
to be an ineffective therapeutic agent. Tuberculin later proved to be a
valuable diagnostic tool.

In 1905,
when Koch was awarded the Nobel Prize in medicine, he devoted his acceptance
speech to promoting greater understanding of tuberculosis and its causative
agent. Koch died in 1910, leaving the scientific community and the world in
general with a valuable inheritance of knowledge and understanding resulting
from his seminal work on anthrax, cholera, trypanosomiasis, and especially
tuberculosis.

In the wake
of Koch's discoveries, subsequent progress in conquering tuberculosis has been
relatively slow. In the laboratory, recognition of the avian bacillus by Nocard
in 1885 and differentiation of bovine and human tubercle bacilli by Theobald
Smith in 1898 laid the groundwork for identification of other (nontuberculous)
mycobacterial species. Diagnosis of tuberculosis was aided by discovery of the
acid-fast nature of the bacillus by Ehrlich in 1882, discovery of X rays by
Roentgen in 1895, development of the tuberculin skin test by Von Pirquet and
Mantoux in 1907-1908, and preparation of purified protein derivative (PPD) of
tuberculin by Seibert in 1931.

In the
1930s, the epidemiologic work of Wade Hampton Frost led to a better
understanding of the epidemiology of tuberculosis. In the 1940s, using
Seibert's PPD administered by the Mantoux method and chest X-ray examinations,
the United States Public Health Service began a series of studies that elucidated
further the epidemiology of tuberculosis and made apparent the distinction
between tuberculous infection without disease (a positive skin test in the
absence of signs and symptoms) and overt clinical tuberculosis.

Treatment
has progressed from bed rest, special diets and fresh air, through pneumothorax
and other lung-collapse procedures and surgical resection, to specific
chemotherapy (streptomycin in 1947, para-aminosalicylic acid in 1949, isoniazid
in 1952, and drugs such as rifampin in recent years). With combinations of
modern drugs properly administered, tuberculosis is now virtually 100% curable.

Prevention
of tuberculosis has been approached in 2 ways. In 1921, Calmette and Guerin
developed an attenuated strain of Mycobacterium bovis, which many countries
throughout the world have used, with variable results, as a vaccine. The other
major approach to prevention has been the treatment of persons with subclinical
tuberculous infection (tuberculous infection without disease) with isoniazid.

There have
been recent improvements in tuberculosis-control methodology. Effective
treatment regimens of 9 months' duration are now available, and research
continues in attempts to further shorten treatment. Fluorescence microscopy has
made the examination of sputum smears faster, easier, and more accurate. Phage
typing is a useful tool for studying the epidemiology of tuberculosis. Newer
immunologic techniques offer promise of improved diagnostic tests, and rapid
radiometric methods of identifying M. tuberculosis and testing for drug
susceptibility are being developed.

In the
century since Koch's discovery, advances in prevention, diagnosis, and
treatment of tuberculosis--especially treatment--have produced a spectacular
decline in tuberculosis mortality and a striking decline in tuberculosis
morbidity--primarily in technically advanced countries (Figure 1). Progress has
been less dramatic in developing countries. Tuberculosis stubbornly persists as
a major worldwide health problem. It is estimated that as many as 10 million
cases of tuberculosis may occur throughout the world each year--4-5 million of
them highly infectious, and 2-3 million resulting in death. Eradication of
tuberculosis, although possibly attainable in technical terms, remains an
elusive goal. Reported by Tuberculosis Control Div, Center for Prevention Svcs,
Mycobacteriology Br, Bacterial Diseases Div, Center for Infectious Diseases,
CDC.

Title photo : SUNRISE

The photograph of 'sunrise' used in the title is taken by me using Sony digicam. No post-processing except I cropped it to fit in the place. Full series of the photos of that sunrise can be seen if you click on the label below: Photos